Giant bilateral angiomyolipomas with spontaneous hemorrhage and inferior vena cava thrombosis in a patient with tuberous sclerosis.

Renal angiomyolipomas are rare type of benign renal neoplasm. They are composed of vascular, smooth and fat elements and can be associated to phacomatosis as Tuberous Sclerosis disease. Symptomatic presentation is most frequently spontaneous retroperitoneal hemorrhage, which can be fatal. The risk of bleeding is proportional to the size of the lesion (>4 cm of diameter). Typical angiomyolipomas are benign but may have alarming properties: nuclear pleomorphism and mitotic activity, extension into the vena cava, and spread to regional lymph nodes without malignant progression. We report a Computed Tomography finding of a rare giant bilateral angiomyolipomas with spontaneous hemorrhage and inferior vena cava thrombus in a patient with tuberous sclerosis, emphasizing the importance of imagery in the positive and etiologic diagnosis.

Navicular tuberculosis: A rare localization of bone tuberculosis.

Tuberculosis (TB) is a global public health problem endemic to Morocco. While extrapulmonary TB uncommonly presents in osteoarticular anatomic locations, tarsal or metatarsal osteitis can occur when TB presents in the tarsal bones. Clinical symptoms are often insidious causing a delay in diagnosis that may lead to bone destruction. While diagnosis can be guided by X-ray imaging, bacteriologic and histologic examination of the tissue allows for pathogen isolation, identification of the bacillus and strain sensitivity to antibacillary treatment. We report a rare case of navicular osteitis associated with tarso-metatarsal arthritis caused by tuberculosis in a 68-year-old man. This case illustrates an exceptional location of osteoarticular TB and support diagnostic difficulties encountered: (i) imaging is not specific; (ii) lesions are paucibacillary which reduces conventional microbiological methods sensitivity and (iii) the peripheral location of the Koch bacillus within the lesion dictates surgical biopsy than percutaneous puncture. We recommend testing for tuberculosis in any case of chronic osteolysis and/or arthritis of the foot, especially in TB endemic countries.

[Voluminous mediastinal neurofibroma in a child]. / Volumineux neurofibrome médiastinal chez un enfant.

INTRODUCTION: Neurogenic tumors account for 30% of mediastinal tumors in children. The thoracic region is the most common site for neurofibromas. We report a case of a voluminous neurofibroma in a small girl. CASE: After 8 months of paraplegia, a 4-year-old girl underwent thoracic radiography and computed tomography as well as magnetic resonance imaging of the spine. These revealed a huge mediastinal mass continuing into the vertebral canal and compressing the cord. Histological examination after surgery confirmed the diagnosis of neurofibroma. At the follow-up examination a month later, the paraplegia had resolved. DISCUSSION: Neurofibromas may manifest as solitary tumors or may be one manifestation of neurofibromatosis. In mediastinal neurofibroma, thoracic radiography, and computed tomography can show the tumor, posterior vertebral scalloping, and enlarged neural foramina. MR imaging provides the exact anatomic location, as well as any compression and displacement caused by the tumor. This information is essential for deciding the exact extent of resection. MRI may also be helpful in postoperative management.